ABSTRACT
To study the value of intensive care in childhood cancer, we evaluated the clinical course and outcome of all such children admitted to our intensive care unit (ICU) (n = 183) during the five-year period from 1984-1988. Excluding those admitted for postoperative observation, there were a total of 63 admissions for complications of malignancy. Of these, admissions for sepsis, pulmonary parenchymal disease, or coma were associated with poor outcome. Thirty-six percent of patients requiring mechanical ventilation for respiratory failure and 27% requiring inotropic support survived longer than six months. Physiologic Stability Index and Therapeutic Intervention Scores were significantly greater in nonsurvivors than survivors. Of those who survived their ICU stay, 50% went home functioning at their premorbid state. The duration of ICU stay was not different in survivors and nonsurvivors, suggesting that intensive care does not excessively prolong the dying process. We conclude that many life-threatening complications of cancer are potentially reversible. The extent of functional recovery of survivors warrants aggressive intensive support in this setting.
Subject(s)
Critical Care , Neoplasms/therapy , Child , Child, Preschool , Costs and Cost Analysis , Critical Care/economics , Female , Humans , Infant , Intensive Care Units, Pediatric/statistics & numerical data , Length of Stay , Male , Michigan , Neoplasms/mortality , Survival Rate , Treatment OutcomeABSTRACT
The fact that patients with hemophilia treated with clotting factor and HIV 1-seronegative subjects with congenital anemias given repeated blood transfusions both have decreased ratios of T4/T8 lymphocytes and diminished NK cell activity indicates that these immunological abnormalities can be due to repeated exposure to blood and blood products, and are not necessarily indicative of HIV 1 infection. To search for an immunological change specific for HIV 1 infection we tested 36 hemophiliacs (22 HIV 1-seropositive, 14 HIV 1-seronegative), and 27 normal subjects for peripheral blood lymphocytes which coexpress Leu 2, a marker associated with suppressor/cytotoxic cells, and Leu 7, an NK cell marker. Compared to normal subjects, seropositive hemophiliacs showed a 2.5-fold increase in Leu 2+ Leu 7+ cells. No increase in this population was seen in the seronegative hemophiliacs. An increase in the percentage of Leu 2+ Leu 7+ cells is therefore an immunological alteration associated with HIV 1 infection but not blood product exposure per se.
